氯氮平与自身免疫反应、发热及轻度心脏毒性相关——病例报告
Clozapine Associated with Autoimmune Reaction, Fever and Low Level Cardiotoxicity - A Case Report.
作者信息
Gerasimou Charilaos, Vitali Georgia Phaedra, Vavougios George D, Papageorgiou Charalabos, Douzenis Athanasios, Kokoris Styliani I, Liappas Ioannis, Rizos Emmanouil
机构信息
Second Department of Psychiatry, Attikon General Hospital, National & Kapodistrian University of Athens, Medical School, Athens, Greece.
Department of Respiratory Medicine, University of Thessaly, School of Medicine, Larissa, Greece.
出版信息
In Vivo. 2017 Jan 2;31(1):141-143. doi: 10.21873/invivo.11037.
BACKGROUND
Clozapine is a second-generation antipsychotic drug used in treatment-resistant schizophrenia. Fever induced by clozapine is a rather frequent side-effect which usually occurs in the first 4 weeks of treatment. Despite its effectiveness, there are potentially life-threatening adverse effects, such as cardiotoxicity.
CASE REPORT
We present the case of a 31-year-old caucasian male with refractory schizophrenia who developed benign fever, increase of C-reactive protein and high troponin levels, without presenting any other signs to myocarditis, on the 13th day under clozapine treatment, which declined progressively upon discontinuation of the drug.
DISCUSSION
This case hints at the presence of initially subclinical cardiotoxicity as an underlying factor in patients developing fever.
CONCLUSION
Taking advantage of more sensitive methods for measuring troponin, clinicians would be promptly aware of this possible side-effect. This would allow for significant reduction of the risk of cardiac dysfunction, further attained by carefully monitoring the patient.
背景
氯氮平是一种用于治疗难治性精神分裂症的第二代抗精神病药物。氯氮平引起的发热是一种相当常见的副作用，通常发生在治疗的前4周。尽管其疗效显著，但存在潜在的危及生命的不良反应，如心脏毒性。
病例报告
我们报告一例31岁的白种男性难治性精神分裂症患者，在氯氮平治疗第13天时出现良性发热、C反应蛋白升高和肌钙蛋白水平升高，未出现任何其他心肌炎体征，停药后这些症状逐渐减轻。
讨论
该病例提示最初存在亚临床心脏毒性是患者发热的潜在因素。
结论
利用更敏感的肌钙蛋白测量方法，临床医生能够及时意识到这种可能的副作用。通过仔细监测患者，这将显著降低心脏功能障碍的风险。
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